CommercialPrior AuthMedium impact
24-1276m Prescribe These Medication-Assisted Treatment Drugs Without Prior Authorization
Health Net·CA · Psychiatry, Family Medicine, Internal Medicine +1 more·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Effective January 1, 2025, California Assembly Bill 1842 eliminates prior authorization requirements for substance use disorder treatment medications including naloxone, buprenorphine products, Sublocade, and Vivitrol for Health Net members. Billing teams can now submit claims for these medication-assisted treatment drugs without obtaining prior authorization.
Action Required
By January 1, 2025: Billing team must update Health Net prior authorization systems to remove PA requirements for substance use disorder medications including naloxone products (Narcan), buprenorphine/naloxone products, Sublocade, and Vivitrol. Update billing software to allow direct claim submission for these drugs without prior authorization holds. Verify monthly formulary updates on Health Net provider portal to confirm which specific products are covered without authorization.